As the world turns...

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Things are unraveling not so fast as I thought, or maybe too fast.  I saw my Pulmonologist yesterday and basically, had a few questions that I wanted to clear up.  I wanted to know the reason for all of these 'appointments', and just to make sure we're on the same page, I wanted to be sure that the reason was to get my medical clearance for surgery. 

As with most Dr's, the right hand didn't know what the left hand was doing...no surprise to me.  She had no idea that my Liver Specialist had sent me to her for medical clearance, what the status was for my transplant, or anything like that.  All she knew, is that I was referred to her, as a pre-liver transplant patient, and needed my PAH (Pulmonary Arterial Hypertension) evaluated.  Now, she had all prior info on the heart catheterization that I had done in March, and based on the levels of pressure in my arteries, I was not clear for surgery.  That's when I was going to Belleview and was put on Viagra (Revatio).  It's been 5 months now that I've been taking the Viagra (time sure does fly...) and, these three tests are needed to determine how the Viagra has changed the PAH.  She (when I refer to 'she', I'm referring to my Pulmonologist, BTW) told me that enough time has elapsed to now show on the Echo cardiogram and Pulmonary Perfusion Imaging tests that they should be able to see the full effects that the Viagra has had on my PAH. 

Now, back in March of this year, when I had the heart catheterization done, I was told before undergoing the procedure that if the pressure was too high, that they would put a stent in my heart, right then and there.  They did not.  I asked her why a stent wasn't put in back in March when I had the Catheterization, if the pressures were so high.  She gave me an important answer that I was not aware of: the heart has 4 chambers, 2 on the left, 2 on the right...the only way that a stent can be placed in the arteries is if theirs hypertension in one of those main chambers.  That's not what PAH is.  It's the arteries that go from my heart to my lungs that have hypertension, thus the name, Pulmonary (lungs) Arterial (in the arteries) Hypertension (high pressure).  Makes sense, right?  So, I asked her why didn't a stent get put into the arteries from my heart to my lungs?  She said that's impossible.  The arteries from the heart to the lungs are on a microscopic level, therefor nothing can be placed in such small arteries to make them expand, this has to be done with medication, to treat the PAH.  Which is what I've been on, the Viagra, since my catheterization results.

Now, there is a bright side, as there usually always is (and me being the eternal pessimist, it's hard for me to say that!), and that is the Pulmonary Function test results that I did on the 8th of this month.  Those test results came back GREAT!  Now, the Pulmonary Function Test is to check the lung capacity, check for blockage in any airways, to see how long I can walk without feeling completely winded, and to see if my lungs are expanding like a normal (more healthy) person.  On the overall, I scored a 76%, and someone without health problems, has a score starting at 70% and up.  So, I'm within normal range.  That means a few things.  It means that my liver/spleen, as big as they are, are still allowing my lungs to expand and are not being hindered (yet) by the hugeness of the liver/spleen.  Also, it means that my lungs are making up for the deficit of my liver, which can only come from one source; the heart.  On the walking test, what they do is get your baseline heart rate, have you walk back and forth for 6 minutes, and each minute, they check this little box that I hold that's attached to my index finger, to check the heart rate.  So, my heart rate was at a 'normal' baseline to start off with, which is good, and it fluctuated during the 6 minute walk (which it should, since as you exert energy, it's only natural for the heart to respond), and they measure what's called the 'come down' meaning after the 6 minute walk, you sit down and they see how long it takes for your heart to reach it's beginning 'baseline'.  This can take up to 6 minutes to happen.  For me, it took 2 minutes, which is awesome! She measured for 3 minutes to be sure that it would stay at that rate and it did. 

These are all good things.  If I do as well on the Echo and the Pulmonary Function tests, then I will get my medical clearance, and things can more forward.  I was also given two puffs of Ventolin throughout this test, since I was prescribed it, once upon a time, and they wanted to see how big a difference it made.  It did make an impressionable difference, so these are all things the Anesthesiologist will need to know before 'putting me under', so I will be given some Ventolin before I go into surgery. 

Unfortunately, my pessemistic attitude can't help but wonder the other possibilities, and it's more than that.  She told me to sign an authorization for my insurance, to approve (I forgot the name, and hopefully, I won't need to know it!) another medication, in the interest of not wasting more precious time, for more medication that I may need.  These last 2 tests are the most crutial ones.  Because PAH shows it's damage in the heart, moreso than in the lungs, and these last 2 tests are testing my heart.  They will be able to get an idea of my heart function through these tests and see the Viagras full effects.  If those effects are not enough to certify me for clearance, than I will be taking this new medication, and in three months time, I will have to get another heart catheterization done.  I really hope that this doesn't happen, and I feel like it's what's going to happen, since they're already having me sign approval's for more medication, I almost feel like I'm being resigned to this fate.  She didn't know that her 'medical approval' for surgery will be the vital kick-off to start the surgery that I need to prolong my life (I hate saying 'save my life', because no life can be saved, death is inevitable, it can only be prolonged, no matter how old you are, and whether it's prolonged for a minute, or fifty years). 

It all boils down to how well I do on these two tests on the 26th and I'm chewing my fingers to stumps till then!  On a different topic, I have my son staying over right now, and he's been bugging me to watch this new xbox game that he borrowed from his friend, so I'm surprised that I've been able to gather my thoughts for this long!

So, I'll check in (maybe) before the 26th, even though, most likely, when I get these tests done, they won't let me know how well I did on them until the 29th, when I get a phone call from Mt. Sinai probably telling me that they're sending the prescription electronically to my pharmacy!  I hate to sound so pessimistic, but I feel like that's what is going to happen.  Anyways, she's not going to be in on the 29th, which is when I was originally supposed to see her, not yesterday, and she's just left instructions to her PA (Physicians Assistant) on how to handle this when the results come in.  I'm keeping my fingers & toes crossed!  Till next time...